Contingent Worker Extension Form - Executive Office Shared Environment

Preparer Name(Required)

Your name

First Last

Preparer UW Email(Required)

Your UW email address

Alternate Contact

In the event of your absence, who should be contacted?

First Last

Alternate Contact UW Email

Alternate contact's UW email address

EO Assistance(Required)

Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form?

No

Yes

Team Member Name

First Last

Contingent Worker Name(Required)

First Last

Contingent Worker Email(Required)

Supplier(Required)

Current Contract End Date(Required)

Extension End Date(Required)

New Contract File Upload(Required)

Upload PDF of new contract.

Accepted file types: pdf, Max. file size: 15 MB.

Documentation

Upload any additional documentation that would be helpful to EOHR Team when reviewing this request.

Drop files here or

Max. file size: 15 MB.

Additional Information

Provide any additional, relevant information on needed action.